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Safieddine B, Grasshoff J, Geyer S, Sperlich S, Epping J, Beller J. Type 2 diabetes in the employed population: do rates and trends differ among nine occupational sectors? An analysis using German health insurance claims data. BMC Public Health 2024; 24:1231. [PMID: 38702701 PMCID: PMC11069294 DOI: 10.1186/s12889-024-18705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle and sedentary behavior, little is known on T2D prevalence and trends among different occupational groups. This study aims to examine occupational sector differences in T2D prevalence and trends thereof between 2012 and 2019. METHODS The study was done on 1.683.644 employed individuals using data from the German statutory health insurance provider in Lower Saxony, the "Allgemeine Ortskrankenkasse Niedersachsen" (AOKN). Predicted probabilities for T2D prevalence in four two-year periods between 2012 and 2019 were estimated based on logistic regression analyses for nine occupational sectors. Prevalence ratios were calculated to illustrate the effect of time period on the prevalence of T2D among the nine occupational sectors. Analyses were stratified by gender and two age groups. RESULTS Results showed differences among occupational sectors in the predicted probabilities for T2D. The occupational sectors "Transport, logistics, protection and security" and "Health sector, social work, teaching & education" had the highest predicted probabilities, while those working in the sector "Agriculture" had by far the lowest predicted probabilities for T2D. Over all, there appeared to be a rising trend in T2D prevalence among younger employed individuals, with gender differences among occupational sectors. CONCLUSION The study displayed different vulnerability levels among occupational sectors with respect to T2D prevalence overall and for its rising trend among the younger age group. Specific occupations within the vulnerable sectors need to be focused upon in further research to define specific target groups to which T2D prevention interventions should be tailored.
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Affiliation(s)
| | - Julia Grasshoff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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Emmert-Fees KMF, Luhar S, O'Flaherty M, Kypridemos C, Laxy M. Forecasting the mortality burden of coronary heart disease and stroke in Germany: National trends and regional inequalities. Int J Cardiol 2023; 393:131359. [PMID: 37757987 DOI: 10.1016/j.ijcard.2023.131359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The decline of cardiovascular disease (CVD) mortality has slowed in many countries, including Germany. We examined the implications of this trend for future coronary heart disease (CHD) and stroke mortality in Germany considering persistent mortality inequalities between former East and West Germany. METHODS We retrieved demographic and mortality data from 1991 to 2019 from the German Federal Statistical Office. Using a Bayesian age-period-cohort framework, we projected CHD and stroke mortality from 2019 to 2035, stratified by sex and German region. We decomposed annual changes in deaths into three components (mortality rates, population age structure and population size) and assessed regional inequalities with age-sex-standardized mortality ratios. RESULTS We confirmed that declines of CVD mortality rates in Germany will likely stagnate. From 2019 to 2035, we projected fewer annual CHD deaths (114,600 to 103,500 [95%-credible interval: 81,700; 134,000]) and an increase in stroke deaths (51,300 to 53,700 [41,400; 72,000]). Decomposing past and projected mortality, we showed that population ageing was and is offset by declining mortality rates. This likely reverses after 2030 leading to increased CVD deaths thereafter. Inequalities between East and West declined substantially since 1991 and are projected to stabilize for CHD but narrow for stroke. CONCLUSIONS CVD deaths in Germany likely keep declining until 2030, but may increase thereafter due to population ageing if the reduction in mortality rates slows further. East-West mortality inequalities for CHD remain stable but may converge for stroke. Underlying risk factor trends need to be monitored and addressed by public health policy.
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Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.
| | - Shammi Luhar
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin O'Flaherty
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Michael Laxy
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
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Voeltz D, Brinks R, Tönnies T, Hoyer A. Future number of people with diagnosed type 1 diabetes in Germany until 2040: an analysis based on claims data. BMJ Open Diabetes Res Care 2023; 11:11/2/e003156. [PMID: 37024151 PMCID: PMC10083786 DOI: 10.1136/bmjdrc-2022-003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION We aim to project the number of people with diagnosed type 1 diabetes in Germany between 2010 and 2040. RESEARCH DESIGN AND METHODS We first estimate the age-specific and sex-specific incidence and prevalence of type 1 diabetes in Germany in 2010 using data from 65 million insurees of the German statutory health insurance. Then, we use the illness-death model to project the prevalence of type 1 diabetes until 2040. We alter the incidence and mortality underlying the illness-death model in several scenarios to explore the impact of possible temporal trends on the number of people with type 1 diabetes. RESULTS Applying the prevalence from 2010 to the official population projections of Germany's Federal Statistical Office yields a total number of 252 000 people with type 1 diabetes in Germany in 2040 (+1% compared with 2010). Incorporating different annual trends of the incidence and mortality in the projection model results in a future number of people with type 1 diabetes between 292 000 (+18%) and 327 000 (+32%). CONCLUSIONS For the first time in Germany, we provide estimates for the incidence, prevalence, and number of people with diagnosed type 1 diabetes for the whole German population between 2010 and 2040. The relative increase of the people with type 1 diabetes ranges from 1% to 32% in 2040 compared with 2010. The projected results are mainly influenced by temporal trends in the incidence. Ignoring these trends, that is, applying a constant prevalence to population projections, probably underestimates future chronic disease numbers.
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Affiliation(s)
- Dina Voeltz
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
- Department of Statistics, Ludwig Maximilians University Munich, Munchen, Germany
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Witten/Herdecke University, Faculty of Health/School of Medicine, Witten, Germany
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
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Understanding the Role of SERCA2a Microdomain Remodeling in Heart Failure Induced by Obesity and Type 2 Diabetes. J Cardiovasc Dev Dis 2022; 9:jcdd9050163. [PMID: 35621874 PMCID: PMC9147026 DOI: 10.3390/jcdd9050163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Obesity and type 2 diabetes (T2D) are on trend to become a huge burden across all ages. They cause harm to almost every organ, especially the heart. For decades, the incidence of heart failure with impaired diastolic function (or called heart failure with preserved ejection fraction, HFpEF) has increased sharply. More and more studies have uncovered obesity and T2D to be closely associated with HFpEF. The sarcoplasmic/endoplasmic reticulum calcium ATPase2a (SERCA2a) microdomain is a key regulator of calcium reuptake into the sarcoplasmic reticulum (SR) during diastole. 3′,5′-cyclic adenosine monophosphate (cAMP) and its downstream effector cAMP dependent protein kinase (PKA) act locally within the SERCA2a microdomain to regulate the phosphorylation state of the small regulatory protein phospholamban (PLN), which forms a complex with SERCA2a. When phosphorylated, PLN promotes calcium reuptake into the SR and diastolic cardiac relaxation by disinhibiting SERCA2a pump function. In this review, we will discuss previous studies investigating the PLN/SERCA2a microdomain in obesity and T2D in order to gain a greater understanding of the underlying mechanisms behind obesity- and T2D-induced diastolic dysfunction, with the aim to identify the current state of knowledge and future work that is needed to guide further research in the field.
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Future prevalence of type 2 diabetes—A comparative analysis of chronic disease projection methods. PLoS One 2022; 17:e0264739. [PMID: 35255104 PMCID: PMC8901066 DOI: 10.1371/journal.pone.0264739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Accurate projections of the future number of people with chronic diseases are necessary for effective resource allocation and health care planning in response to changes in disease burden. Aim To introduce and compare different projection methods to estimate the number of people with diagnosed type 2 diabetes (T2D) in Germany in 2040. Methods We compare three methods to project the number of males with T2D in Germany in 2040. Method 1) simply combines the sex- and age-specific prevalence of T2D in 2010 with future population distributions projected by the German Federal Statistical Office (FSO). Methods 2) and 3) additionally account for the incidence of T2D and mortality rates using partial differential equations (PDEs). Method 2) models the prevalence of T2D employing a scalar PDE which incorporates incidence and mortality rates. Subsequently, the estimated prevalence is applied to the population projection of the FSO. Method 3) uses a two-dimensional system of PDEs and estimates future case numbers directly while future mortality of people with and without T2D is modelled independently from the projection of the FSO. Results Method 1) projects 3.6 million male people with diagnosed T2D in Germany in 2040. Compared to 2.8 million males in 2010, this equals an increase by 29%. Methods 2) and 3) project 5.9 million (+104% compared to 2010) and 6.0 million (+116%) male T2D patients, respectively. Conclusions The results of the three methods differ substantially. It appears that ignoring temporal trends in incidence and mortality may result in misleading projections of the future number of people with chronic diseases. Hence, it is essential to include these rates as is done by method 2) and 3).
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Vandenberghe D, Albrecht J. The financial burden of non-communicable diseases in the European Union: a systematic review. Eur J Public Health 2021; 30:833-839. [PMID: 31220862 DOI: 10.1093/eurpub/ckz073] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) impose a significant and growing burden on the health care system and overall economy of developed (and developing) countries. Nevertheless, an up-to-date assessment of this cost for the European Union (EU) is missing from the literature. Such an analysis could however have an important impact by motivating policymakers and by informing effective public health policies. METHODS Following the PRISMA protocol, we conduct a systematic review of electronic databases (PubMed/Medline, Embase, Web of Science Core Collection) and collect scientific articles that assess the direct (health care-related) and indirect (economic) costs of four major NCDs (cardiovascular disease, cancer, type-2 diabetes mellitus and chronic respiratory disease) in the EU, between 2008 and 2018. Data quality was assessed through the Newcastle-Ottawa Scale. RESULTS We find 28 studies that match our criteria for further analysis. From our review, we conclude that the four major NCDs in the EU claim a significant share of the total health care budget (at least 25% of health spending) and they impose an important economic loss (almost 2% of gross domestic product). CONCLUSION The NCD burden forms a public health risk with a high financial impact; it puts significant pressure on current health care and economic systems, as shown by our analysis. We identify a further need for cost analyses of NCDs, in particular on the impact of comorbidities and other complications. Aside from cost estimations, future research should focus on assessing the mix of public health policies that will be most effective in tackling the NCD burden.
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Affiliation(s)
- Désirée Vandenberghe
- Department of Economics, Faculty of Economics and Business Administration, Ghent University, Gent, Belgium
| | - Johan Albrecht
- Department of Economics, Faculty of Economics and Business Administration, Ghent University, Gent, Belgium
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Monteiro C, Silvestre S, Duarte AP, Alves G. Assessment of suspected adverse drug reactions in elderly patients with diabetes mellitus based on a Portuguese spontaneous reporting database: analysis of reporting from 2008 to 2018. Expert Opin Drug Saf 2021; 20:845-853. [PMID: 33962523 DOI: 10.1080/14740338.2021.1928072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Age is one of the most important risk factors in the development of diabetes mellitus and certain drug classes indicated for this condition may be associated with clinically important adverse drug reactions (ADRs). The aim of this study was to analyze the suspected ADRs in older patients with diabetes mellitus, reported to the Portuguese Pharmacovigilance System from 2008 to 2018. RESEARCH DESIGN AND METHODS A retrospective analysis of suspected ADRs reports was performed, involving patients aged ≥65 years. RESULTS Of a total of 751 reports collected, 439 were considered serious, 199 led to hospitalization and in 19 of them occurred a fatal outcome. Most of them were observed in females (n = 393) and involved patients belonging mainly to the age group 65-74 years (n = 405). Taking into account a total of 2134 suspected ADRs, the most frequent were hypoglycemia (2.67%) and lactic acidosis (2.62%). The drugs specifically indicated for glycemic control were the most frequently involved in ADRs. CONCLUSIONS Most of the ADRs were reported as serious and were mainly associated to drugs in diabetes mellitus. In addition, the majority of them, such as hypoglycemia, are preventable, highlighting the importance to identify possible factors that determine this occurrence, especially in the elderly.
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Affiliation(s)
- Cristina Monteiro
- UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
| | - Samuel Silvestre
- CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Ana Paula Duarte
- UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal.,CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Gilberto Alves
- UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal.,CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,ESALD-IPCB - Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
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Stegbauer C, Falivena C, Moreno A, Hentschel A, Rosenmöller M, Heise T, Szecsenyi J, Schliess F. Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies. BMC Health Serv Res 2020; 20:1043. [PMID: 33198734 PMCID: PMC7667793 DOI: 10.1186/s12913-020-05897-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies. METHODS A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively. RESULTS From 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found. CONCLUSIONS Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.
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Affiliation(s)
- Constance Stegbauer
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany.
| | - Camilla Falivena
- Health & Not for Profit Division, CERGAS, SDA Bocconi School of Management Governments, Via Sarfatti, 10, Milan, 20136, Italy
| | - Ariadna Moreno
- CRHIM - Center for Research in Healthcare Innovation Management, IESE Business School - University of Navarra, C. d'Arnús i de Garí, 3-7, Barcelona, 08034, Catalonia, Spain
| | - Anna Hentschel
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany
| | - Magda Rosenmöller
- CRHIM - Center for Research in Healthcare Innovation Management, IESE Business School - University of Navarra, C. d'Arnús i de Garí, 3-7, Barcelona, 08034, Catalonia, Spain
| | - Tim Heise
- Profil, Hellersbergstr. 9, Neuss, 41460, North Rhine-Westphalia, Germany
| | - Joachim Szecsenyi
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Lower Saxony, Germany
| | - Freimut Schliess
- Profil, Hellersbergstr. 9, Neuss, 41460, North Rhine-Westphalia, Germany
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Libiseller A, Kopanz J, Lichtenegger KM, Mader JK, Truskaller T, Lackner B, Aberer F, Pandis M, Reinisch-Gratzer J, Ambrosch GC, Sinner F, Pieber TR, Donsa K. Study protocol for assessing the user acceptance, safety and efficacy of a tablet-based workflow and decision support system with incorporated basal insulin algorithm for glycaemic management in participants with type 2 diabetes receiving home health care: A single-centre, open-label, uncontrolled proof-of-concept study. Contemp Clin Trials Commun 2020; 19:100620. [PMID: 32775762 PMCID: PMC7399114 DOI: 10.1016/j.conctc.2020.100620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/22/2020] [Accepted: 07/12/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction Diabetes management can be especially complex for older adults who receive health care at home. Thus, international guidelines recommend basal-insulin regimens due to simpler handling and low hypoglycaemia risk. A basal-insulin algorithm (including basal-plus) was developed to also include participant's health status and subsequently implemented into a tablet-based workflow and decision support system, GlucoTab@MobileCare. This study protocol describes a proof-of-concept study to investigate user acceptance, safety and efficacy of the GlucoTab@MobileCare system in participants receiving home health care. Methods The open-label, single-centre, uncontrolled study will recruit a maximum of ten participants with insulin treated type-2-diabetes (age ≥18 years) who receive home health care. During a three month study period participants will receive basal- or basal-plus-insulin therapy once daily as suggested by the GlucoTab@MobileCare system. Statistical analysis will be conducted on an intention-to-treat basis. The primary endpoint is the percentage of tasks (BG measurements, insulin dose calculations, insulin injections) that were performed according to GlucoTab@MobileCare suggestions relative to the total of suggested tasks. Secondary endpoints include user acceptance, safety and efficacy parameters. The study was approved by the ethics committee and regulatory authorities. Before obtaining written informed consent, all participants will receive oral and written information about all aspects of the study. Results will be published in a peer-reviewed journal and at diabetes and geriatric conferences. Discussion Potential implications may be improved quality and safety of basal-insulin therapy in older adults as well as support for health-care-providers in daily routine including evidence-based knowledge. Trial registration German Clinical Trials Register (DRKS00015059);
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Affiliation(s)
- Angela Libiseller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Julia Kopanz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Katharina M Lichtenegger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Thomas Truskaller
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Bettina Lackner
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Marlene Pandis
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | | | - Frank Sinner
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria.,JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria.,JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Klaus Donsa
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
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Tan KW, Dickens BSL, Cook AR. Projected burden of type 2 diabetes mellitus-related complications in Singapore until 2050: a Bayesian evidence synthesis. BMJ Open Diabetes Res Care 2020; 8:8/1/e000928. [PMID: 32184203 PMCID: PMC7076230 DOI: 10.1136/bmjdrc-2019-000928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/16/2020] [Accepted: 02/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We examined the effects of age, gender, and ethnicity on the risk of acute myocardial infarction, stroke, and end-stage renal disease according to type 2 diabetes mellitus status among adults aged 40-79 in Singapore. METHODS A Bayesian inference framework was used to derive age-specific, gender-specific and ethnicity-specific prevalence of type 2 diabetes mellitus from the 2010 Singapore National Health Survey, and age-standardized gender and ethnicity-specific incidence rates of acute myocardial infarction, stroke and end-stage renal disease from the National Registry of Diseases Office. Population forecasts were used in tandem with incidence rates to project the future chronic disease burden until 2050. RESULTS The highest relative risk of acute myocardial infarction was observed in the youngest age group (aged 40-44), with higher relative risk for women (men: 4.3 (2.7-6.4); women: 16.9 (9.3-28.3)). A similar trend was observed for stroke (men: 6.5 (4.2-9.7); women: 10.7 (6.0-17.4)). For end-stage renal disease, the highest relative risk was for men aged 45-50 (11.8 (8.0-16.9)) and women aged 55-60 (16.4 (10.7-24.0)). The annual incidence of acute myocardial infarction is projected to rise from 9300 (in 2019) to 16 400 (in 2050), the number of strokes from 7300 to 12 800, and the number of end-stage renal disease cases from 1700 to 2700. CONCLUSIONS Type 2 diabetes mellitus was associated with an increased risk of complications and is modulated by age and gender. Prevention and early detection of type 2 diabetes mellitus can reduce the increasing burden of secondary complications.
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Affiliation(s)
- Ken Wei Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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12
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[The future development of dementia diseases in Germany-a comparison of different forecast models]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:993-1003. [PMID: 31243489 DOI: 10.1007/s00103-019-02981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dementia is one of the most frequent diseases of people aged 65 and older. As a result of the upcoming demographic transition, a significant increase is expected to the current number of around 1.7 million dementia patients. A precise estimate of this increase is especially important for decision-makers and payers to the health-care system. This study examined the effects of different assumptions on the future frequency of disease using a time-discrete Markov model with population-related and disease-specific components. Based on health insurers' administrative data from AOK Baden-Württemberg, we determined age- and gender-specific prevalence rates, incidence rates, and mortality differences of dementia patients and combined them with demographic components from German population statistics. As a result, our Markov model showed a 20 to 25% higher number of dementia patients in 2030, compared to the results of the status quo projection applied in most previous studies, with the assumption of constant prevalence rates over time. Hence, our results indicate that even in the medium term payers will have to face significant increases in dementia-related health expenditures. By 2060, the number of dementia patients in Germany would rise to 3.3 million assuming a further increase to life expectancy and constant incidence rates over time. The assumption of a compression of the morbidity would reduce this number to 2.6 million.
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Bramlage P, Lanzinger S, van Mark G, Hess E, Fahrner S, Heyer CHJ, Friebe M, Seufert J, Danne T, Holl RW. Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases. Cardiovasc Diabetol 2019; 18:33. [PMID: 30878037 PMCID: PMC6420726 DOI: 10.1186/s12933-019-0837-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany. METHODS Using combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR < 60 mL/min/1.73 m2 or eGFR ≥ 60 mL/min/1.73 m2 and albuminuria (≥ 30 mg/g). Median values of the most recent treatment year per patient are reported. RESULTS Among 343,675 patients with T2DM 171,930 had CKD. Patients with CKD had a median eGFR of 48.9 mL/min/1.73 m2 and 51.2% had a urinary albumin level ≥ 30 mg/g. They were older, had a longer diabetes duration and a higher proportion was females compared to patients without CKD (all p < 0.001). More than half of CKD patients (53.5%) were receiving long-acting insulin-based therapy versus around 39.1% of those without (p < 0.001). CKD patients also had a higher rate of hypertension (79.4% vs 72.0%; p < 0.001). The most common antihypertensive drugs among CKD patients were renin-angiotensin-aldosteron system inhibitors (angiotensin converting enzyme inhibitors 33.8%, angiotensin receptor blockers 14.2%) and diuretics (40.2%). CKD patients had a higher rate of dyslipidemia (88.4% vs 86.3%) with higher triglyceride levels (157.9 vs 151.0 mg/dL) and lower HDL-C levels (men: 40.0 vs 42.0 mg/dL; women: 46.4 vs 50.0 mg/dL) (all p < 0.001) and a higher rate of hyperkalemia (> 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p < 0.001). CONCLUSION The results illustrate the prevalence and morbidity burden associated with diabetic kidney disease in patients with T2DM in Germany. The data call for more attention to the presence of chronic kidney disease in patients with diabetes, should trigger intensified risk factor control up and beyond the control of blood glucose and HbA1c in these patients. They may also serve as a trigger for future investigations into this patient population asking for new treatment options to be developed.
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Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661 Cloppenburg, Germany
| | - Stefanie Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, Neuherberg, Munich, Germany
| | - Gesine van Mark
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661 Cloppenburg, Germany
| | - Eva Hess
- Diabetologische Schwerpunktpraxis Dres. Hess, Worms, Germany
| | - Simon Fahrner
- Medizinische Klinik, SRH Klinik Sigmaringen, Pfullendorf, Germany
| | | | | | - Jochen Seufert
- Universitätsklinikum Freiburg, Medizinische Fakultät, Freiburg, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, Neuherberg, Munich, Germany
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Buchan JC, Norman P, Shickle D, Cassels-Brown A, MacEwen C. Failing to plan and planning to fail. Can we predict the future growth of demand on UK Eye Care Services? Eye (Lond) 2019; 33:1029-1031. [PMID: 30814654 DOI: 10.1038/s41433-019-0383-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/06/2019] [Accepted: 02/13/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- John Cameron Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Darren Shickle
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Carrie MacEwen
- Department of Ophthalmology, Ninewells Hospital, University of Dundee, Dundee, UK
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Khanal S, Veerman L, Nissen L, Hollingworth S. Forecasting the amount and cost of medicine to treat type 2 diabetes mellitus in Nepal using knowledge on medicine usage from a developed country. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
This research was aimed to forecast the amount and cost of medicines required to treat people with type 2 diabetes mellitus (T2DM) in Nepal over 30 years.
Methods
We modelled the financial burden of T2DM medicines by estimating the cost of medicines to treat all cases of T2DM in Nepal over three decades based on the prevalence of T2DM in Nepal, the Nepalese costs of medicine and the T2DM medicine use profile of Australia.
Key findings
With the current T2DM prevalence trend, it would cost US$63–95 million in 2013 to purchase T2DM medicines for Nepal, if Nepalese receive the same mix of T2DM medicines as used in Australia. This cost is almost one-quarter of the total health budget of Nepal (US$308 million). The cost of medicines to treat T2DM is projected to triple between 2013 and 2043.
Conclusions
With the medicines for only T2DM projected to cost about 25% of the entire health budget, the planned health insurance seems unaffordable if patients are treated with the same medicines as those in one of the best healthcare systems in the world. The government needs to stimulate rational prescribing and secure additional funding through taxation, health insurance or health levy to provide such medicines and services.
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Affiliation(s)
- Saval Khanal
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Lennert Veerman
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Abstract
PURPOSE OF REVIEW The economic burden of diabetes in Japan is already serious and will become greater in the future. We review the economic impact of diabetes in Japan to examine viable options for mitigating its effects. RECENT FINDINGS Medical costs for diabetes have been increasing by US $1 million annually, reaching US $11 million in 2009, of which US $7 million was accounted for by people aged 65 years or older. The quality of treatment of diabetes in Japan is higher than in other regions in the world. This can be more effective for achieving glycemic control, but is also more expensive compared with conventional treatment. Because of the high cost of diabetes in Japan, a coordinated response is needed. Intervention trials for people with prediabetes aimed at preventing the occurrence of diabetes seem to be the most cost-effective method for lowering the medical costs of diabetes, rather than the use of new, expensive antidiabetic drugs in patients with established diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, Japan.
| | - Remi Kuwabara
- Department of Pediatrics, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, Japan
| | - Kei Yoshida
- Department of Pediatrics, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, Japan
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Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnighausen T, Davies J, Vollmer S. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care 2018; 41:963-970. [PMID: 29475843 DOI: 10.2337/dc17-1962] [Citation(s) in RCA: 526] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/30/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite the importance of diabetes for global health, the future economic consequences of the disease remain opaque. We forecast the full global costs of diabetes in adults through the year 2030 and predict the economic consequences of diabetes if global targets under the Sustainable Development Goals (SDG) and World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 are met. RESEARCH DESIGN AND METHODS We modeled the absolute and gross domestic product (GDP)-relative economic burden of diabetes in individuals aged 20-79 years using epidemiological and demographic data, as well as recent GDP forecasts for 180 countries. We assumed three scenarios: prevalence and mortality 1) increased only with urbanization and population aging (baseline scenario), 2) increased in line with previous trends (past trends scenario), and 3) achieved global targets (target scenario). RESULTS The absolute global economic burden will increase from U.S. $1.3 trillion (95% CI 1.3-1.4) in 2015 to $2.2 trillion (2.2-2.3) in the baseline, $2.5 trillion (2.4-2.6) in the past trends, and $2.1 trillion (2.1-2.2) in the target scenarios by 2030. This translates to an increase in costs as a share of global GDP from 1.8% (1.7-1.9) in 2015 to a maximum of 2.2% (2.1-2.2). CONCLUSIONS The global costs of diabetes and its consequences are large and will substantially increase by 2030. Even if countries meet international targets, the global economic burden will not decrease. Policy makers need to take urgent action to prepare health and social security systems to mitigate the effects of diabetes.
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Affiliation(s)
- Christian Bommer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | - Vera Sagalova
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | - Esther Heesemann
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.,Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- Centre for Global Health, King's College London, London, U.K.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
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Jacobs E, Hoyer A, Brinks R, Icks A, Kuß O, Rathmann W. Healthcare costs of Type 2 diabetes in Germany. Diabet Med 2017; 34:855-861. [PMID: 28199029 DOI: 10.1111/dme.13336] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 01/23/2023]
Abstract
AIM To describe for the first time the direct costs of Type 2 diabetes treatment by analysing nationwide routine data from statutory health insurance in Germany. METHODS This cost-of-illness-study was based on a 6.8% random sample of all German people with statutory health insurance (4.3 out of 70 million people). The healthcare expenses show direct per capita costs from the payer perspective. Healthcare expenses for physicians, dentists, pharmacies, hospitals, sick benefits and other healthcare costs were considered. Per capita costs, cost ratios for people with Type 2 diabetes and without diabetes as well as diabetes-attributable costs were calculated. RESULTS Per capita costs for people with Type 2 diabetes amounted to €4,957 in 2009 and €5,146 in 2010. People with Type 2 diabetes had 1.7-fold higher health expenses than people without diabetes. The largest differences in health expenses were found for prescribed medication from pharmacies (cost ratio diabetes/no diabetes: 2.2) and inpatient treatment (1.8). Ten percent of the total statutory health insurance expense, in total €16.1 billion, was attributable to the medical care of people with Type 2 diabetes. CONCLUSIONS This nationwide study indicates that one in 10 Euros of healthcare expenses is spent on people with Type 2 diabetes in Germany. In the future, national statutory health insurance data can be used to quantify time trends of costs in the healthcare system.
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Affiliation(s)
- E Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
| | - A Hoyer
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - R Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - A Icks
- Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
- Institute for Health Service Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - O Kuß
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
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Muschik D, Tetzlaff J, Lange K, Epping J, Eberhard S, Geyer S. Change in life expectancy with type 2 diabetes: a study using claims data from lower Saxony, Germany. Popul Health Metr 2017; 15:5. [PMID: 28193279 PMCID: PMC5307777 DOI: 10.1186/s12963-017-0124-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background This study estimates life expectancy with and without type 2 diabetes for individuals in Lower Saxony, Germany in order to detect a trend in population health. Methods Morbidity and mortality data derived from German administrative claims data (statutory health insurance, AOK Niedersachsen, N = 2,900,065) were used covering 10 years from 2005 to 2014. Life table analysis was applied for calculating life expectancy, life expectancy free of type 2 diabetes, life expectancy with type 2 diabetes, and the proportion of life expectancy free of diabetes to total life expectancy using the Sullivan method. Results The total life expectancy increase is stronger in men than in women: At the age of 20, total life expectancy was 55.0 years in 2005 and 56.3 years in 2014 for men, whereas it was 61.7 years in 2005 and 62.5 years in 2014 for women. Decreases in life expectancy without type 2 diabetes were more pronounced in women than in men. Accordingly, life expectancy with type 2 diabetes increased in both women and in men. The proportion of life expectancy without diabetes to total life expectancy decreased, indicating a similar development in both. For example, at the age of 60, the proportion of life expectancy without diabetes to total life expectancy decreased from 0.75 in 2005 to 0.66 in 2014 for men, while it decreased from 0.77 in 2005 to 0.70 in 2014 for women. Conclusions Against the background of increasing total life expectancy, the time spent in morbidity increased for the case of type 2 diabetes in Lower Saxony, Germany.
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Affiliation(s)
- Denise Muschik
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen - Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Diabetes-Associated Factors as Predictors of Nursing Home Admission and Costs in the Elderly Across Europe. J Am Med Dir Assoc 2017; 18:74-82. [DOI: 10.1016/j.jamda.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022]
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Jacob L, von Vultee C, Kostev K. Prescription Patterns and the Cost of Antihyperglycemic Drugs in Patients With Type 2 Diabetes Mellitus in Germany. J Diabetes Sci Technol 2017; 11:123-127. [PMID: 27402240 PMCID: PMC5375068 DOI: 10.1177/1932296816658746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patients with type 2 diabetes (T2DM) treated in Germany in 2015. METHODS This study included 36382 patients aged 40 years or over treated in general practices (GPs) and diabetologist practices who were diagnosed with T2DM in 2015. Nine different families of antihyperglycemic therapy were included in the analysis. Demographic data included age, gender, and type of health insurance coverage. Clinical data included HbA1c level, body mass index (BMI), and the number of T2DM complications. The annual antihyperglycemic treatment cost per patient was calculated based on pharmacy retail prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. RESULTS The percentage of T2DM patients receiving antihyperglycemic treatments was 87.6. This share was slightly higher in men than in women (89.1% vs 86.0%). Interestingly, the share of people treated with antihyperglycemic drugs decreased with age yet increased with HbA1c levels, BMI, and the number of complications. The average annual cost of antihyperglycemic drugs amounted to €498. It was significantly higher in men than in women (difference of €22). It was also significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €153). The annual cost decreased with age. It is compelling to note that this cost increased with HbA1c levels and BMI. Finally, the annual cost also increased with the number of complications. CONCLUSIONS The share and the cost of antihyperglycemic treatments vary with gender, age, type of health insurance coverage, HbA1c levels, BMI, and the number of complications.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | | | - Karel Kostev
- IMS Health, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, IMS Health, Epidemiology, Darmstädter Landstraße 1089, 60598 Frankfurt am Main, Germany.
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Andersson T, Ahlbom A, Carlsson S. Diabetes Prevalence in Sweden at Present and Projections for Year 2050. PLoS One 2015; 10:e0143084. [PMID: 26619340 PMCID: PMC4664416 DOI: 10.1371/journal.pone.0143084] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/02/2015] [Indexed: 02/07/2023] Open
Abstract
Background Data on the future diabetes burden in Scandinavia is limited. Our aim was to project the future burden of diabetes in Sweden by modelling data on incidence, prevalence, mortality, and demographic factors. Method To project the future burden of diabetes we used information on the prevalence of diabetes from the national drug prescription registry (adults ≥20 years), previously published data on relative mortality in people with diabetes, and population demographics and projections from Statistics Sweden. Alternative scenarios were created based on different assumptions regarding the future incidence of diabetes. Results Between 2007 and 2013 the prevalence of diabetes rose from 5.8 to 6.8% in Sweden but incidence remained constant at 4.4 per 1000 (2013). With constant incidence and continued improvement in relative survival, prevalence will increase to 10.4% by year 2050 and the number of afflicted individuals will increase to 940 000. Of this rise, 30% is accounted for by changes in the age structure of the population and 14% by improved relative survival in people with diabetes. A hypothesized 1% annual rise in incidence will result in a prevalence of 12.6% and 1 136 000 cases. Even with decreasing incidence at 1% per year, prevalence of diabetes will continue to increase. Conclusion We can expect diabetes prevalence to rise substantially in Sweden over the next 35 years as a result of demographic changes and improved survival among people with diabetes. A dramatic reduction in incidence is required to prevent this development.
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Affiliation(s)
- Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anders Ahlbom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis. PLoS One 2015. [PMID: 26200913 PMCID: PMC4511591 DOI: 10.1371/journal.pone.0132505] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030. Methods A Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model. Results We estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030. Conclusions The economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority.
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Brinks R, Hoyer A, Tamayo T, Kowall B, Rathmann W. Years of life lost. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:211. [PMID: 25838026 PMCID: PMC4395766 DOI: 10.3238/arztebl.2015.0211a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int 2015; 26:1929-37. [PMID: 25761729 DOI: 10.1007/s00198-015-3093-2] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED A state-transition microsimulation model was used to project the substantial economic burden to the Chinese healthcare system of osteoporosis-related fractures. Annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. Consequently, cost-effective intervention policies must urgently be identified in an attempt to minimize the impact of fractures. INTRODUCTION The aim of the study was to project the osteoporosis-related fractures and costs for the Chinese population aged ≥50 years from 2010 to 2050. METHODS A state-transition microsimulation model was used to simulate the annual incident fractures and costs. The simulation was performed with a 1-year cycle length and from the Chinese healthcare system perspective. Incident fractures and annual costs were estimated from 100 unique patient populations for year 2010, by multiplying the age- and sex-specific annual fracture risks and costs of fracture by the corresponding population totals in each of the 100 categories. Projections for 2011-2050 were performed by multiplying the 2010 risks and costs of fracture by the respective annual population estimates. Costs were presented in 2013 US dollars. RESULTS Approximately 2.33 (95 % CI 2.08, 2.58) million osteoporotic fractures were estimated to occur in 2010, costing $9.45 (95 % CI 8.78, 10.11) billion. Females sustained approximately three times more fractures than males, accounting for 76 % of the total costs from 1.85 (95 % CI 1.68, 2.01) million fractures. The annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. CONCLUSIONS Our study demonstrated that osteoporosis-related fractures cause a substantial economic burden which will markedly increase over the coming decades. Consequently, healthcare resource planning must consider these increasing costs, and cost-effective screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget.
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Affiliation(s)
- L Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
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Paraponaris A, Davin B. Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:368-375. [PMID: 26091590 DOI: 10.1016/j.jval.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/21/2014] [Accepted: 01/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized. METHODS Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia. RESULTS More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year. CONCLUSIONS The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care.
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Affiliation(s)
- Alain Paraponaris
- INSERM, UMR912 (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, South-Eastern Health Observatory, Marseille, France; Aix-Marseille School of Economics (AMSE), Marseille, France.
| | - Bérengère Davin
- INSERM, UMR912 (SESSTIM), Marseille, France; ORS PACA, South-Eastern Health Observatory, Marseille, France
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Projected effect of increased active travel in German urban regions on the risk of type 2 diabetes. PLoS One 2015; 10:e0122145. [PMID: 25849819 PMCID: PMC4388533 DOI: 10.1371/journal.pone.0122145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/07/2015] [Indexed: 11/25/2022] Open
Abstract
Background Future transportation policy is likely to reduce emissions in the cities and urban regions by strengthening active travel. Increased walking and cycling are known to have positive effects on health outcomes. This work estimates effects of increased active travel on type 2 diabetes in Germany, where 64% of the population live in urban regions. Methods Based on the effect size of an increased active travel scenario reported from a recent meta-analysis, we project the change in the life time risk, the proportion of prevented cases and the change in diabetes free life time in a German birth cohort (born 1985) compared to business as usual. Results The absolute risk reduction of developing type 2 diabetes before the age of 80 is 6.4% [95% confidence interval: 3.7-9.7%] for men and 4.7% [2.2-7.7%] for women, respectively. Compared to business as usual, the increased active travel scenario prevents 14.0% [8.1-21.2%] of the future cases of diabetes in men and 15.8% [9.3-23.1%] in women. Diabetes free survival increases by 1.7 [1.0-2.7] years in men and 1.4 [0.6-2.3] in women. Conclusions Our projection predicts a substantial impact of increased active travel on the future burden of type 2 diabetes. The most striking effect may be seen in the number of prevented cases. In all urban regions with an increased active travel transport policy, about one out of seven male and one out of six female cases can be prevented.
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Brinks R, Landwehr S. Change rates and prevalence of a dichotomous variable: simulations and applications. PLoS One 2015; 10:e0118955. [PMID: 25749133 PMCID: PMC4352043 DOI: 10.1371/journal.pone.0118955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
A common modelling approach in public health and epidemiology divides the population under study into compartments containing persons that share the same status. Here we consider a three-state model with the compartments: A, B and Dead. States A and B may be the states of any dichotomous variable, for example, Healthy and Ill, respectively. The transitions between the states are described by change rates, which depend on calendar time and on age. So far, a rigorous mathematical calculation of the prevalence of property B has been difficult, which has limited the use of the model in epidemiology and public health. We develop a partial differential equation (PDE) that simplifies the use of the three-state model. To demonstrate the validity of the PDE, it is applied to two simulation studies, one about a hypothetical chronic disease and one about dementia in Germany. In two further applications, the PDE may provide insights into smoking behaviour of males in Germany and the knowledge about the ovulatory cycle in Egyptian women.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- * E-mail:
| | - Sandra Landwehr
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- Department of Medical Statistics, Heinrich-Heine-University, Duesseldorf, Germany
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Yıldız H, Bölüktaş RP. Evaluation of Sexual Dysfunction in Males with Diabetes. SEXUALITY AND DISABILITY 2015. [DOI: 10.1007/s11195-015-9397-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Göke R, Bader G, Dworak M. Real-life effectiveness and tolerability of vildagliptin and other oral glucose-lowering therapies in patients with type 2 diabetes in Germany. Diabetes Ther 2014; 5:183-91. [PMID: 24643724 PMCID: PMC4065295 DOI: 10.1007/s13300-014-0060-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Metformin is an established first-line treatment for patients with type 2 diabetes mellitus (T2DM), but treatment intensification with other oral antidiabetes drugs (OADs) is usually required over time. Effectiveness of diabetes control with vildagliptin and vildagliptin/metformin was a 1-year, large observational study of 45,868 patients with T2DM across 27 countries which assessed effectiveness and safety of vildagliptin as add-on therapy to other OADs versus other comparator OAD combinations. Here, we present the data from Germany. METHODS Patients inadequately controlled with monotherapy were eligible only after the add-on treatment was finalized. Patients were assigned to either vildagliptin or comparator OADs [sulfonylureas, thiazolidinediones, glinides, α-glucosidase inhibitors or metformin, excluding dipeptidyl peptidase 4 (DPP-4) inhibitors or glucagon-like peptide-1 mimetic/analogues]. The primary efficacy endpoint was the proportion of patients achieving a glycosylated hemoglobin (HbA1c) reduction of >0.3% without peripheral edema, hypoglycemia, discontinuation due to a gastrointestinal event or weight gain ≥5%. One secondary efficacy endpoint was the proportion of patients achieving HbA1c <7% without hypoglycemia and weight gain. Change in HbA1c from baseline to study endpoint and safety were assessed. RESULTS Of 8,887 patients enrolled in Germany, 6,679 received vildagliptin and 1,695 received other OADs. The mean ± SD baseline age, HbA1c, and T2DM duration were 62.8 ± 11.0 years, 7.7 ± 1.2%, and 5.8 ± 4.9 years, respectively. The proportion of patients achieving the primary (34.5% vs. 30.5%, p < 0.01) and secondary (25.4% vs. 21.7%, p = 0.01) endpoints was higher with vildagliptin than comparator OADs. Vildagliptin showed a numerically greater reduction in HbA1c (0.7%) from baseline vs. comparator OADs (0.6%). The overall incidence of adverse events was similar. CONCLUSION In real life, treatment with vildagliptin is associated with a higher proportion of patients reaching target HbA1c without hypoglycemia and weight gain compared with other OADs in Germany.
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Affiliation(s)
- Rüdiger Göke
- Diabetes Center, Dietersdorfer Weg 2, 35041, Marburg, Germany,
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Göke R, Gruenberger JB, Bader G, Dworak M. Real-life efficacy and safety of vildagliptin compared with sulfonylureas as add-on to metformin in patients with type 2 diabetes mellitus in Germany. Curr Med Res Opin 2014; 30:785-9. [PMID: 24328429 DOI: 10.1185/03007995.2013.875464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Metformin is an established first-line treatment for type 2 diabetes mellitus (T2DM) patients, but intensification of oral anti-diabetes therapy is usually required over time. A large observational study of 45,868 T2DM patients in 27 countries (EDGE) was conducted to compare the effectiveness and safety of vildagliptin as add-on therapy to another oral anti-diabetes drug (OAD) vs other dual OAD combinations. This report presents results from a post-hoc analysis of patients in Germany who received vildagliptin or a sulfonylurea (SU) in combination with metformin. RESEARCH DESIGN AND METHODS Patients inadequately controlled with monotherapy became eligible only after the add-on treatment was finalized. Patients included were assigned to receive either vildagliptin or another OAD (SUs, thiazolidinediones, glinides, α-glucosidase inhibitors, or metformin; DPP-4 inhibitors or glucagon-like peptide-1 [GLP-1] mimetics/analogs were excluded). The primary end-point was the proportion of patients achieving a reduction in HbA1c >0.3% without peripheral edema, hypoglycemia, discontinuation due to gastrointestinal event, or weight gain ≥5%. RESULTS Of 8887 patients enrolled in Germany, 6439 received vildagliptin and 971 received SUs as add-on to metformin. The primary end-point was reached in 34.9% and 29.6% of patients in the vildagliptin and SU groups, respectively, with an unadjusted odds ratio of 1.27 (95% CI = 1.09, 1.47; p = 0.001). HbA1c decreased in both cohorts from baseline (-0.7% with vildagliptin vs -0.5% with SUs), with a mean between-group difference of -0.2% (95% CI = -0.22, -0.09). The number of hypoglycemic events was 4-fold higher in the SU group than in the vildagliptin group (vildagliptin = 0.11%; SU = 0.41%). CONCLUSIONS In a real-life setting, vildagliptin was associated with a numerically greater reduction in HbA1c, less hypoglycemia, and more patients reaching target HbA1c without hypoglycemia or weight gain compared with SUs. Open-label design and under reporting of adverse events are limitations of this post hoc analysis.
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Affiliation(s)
- R Göke
- University of Marburg , Marburg , Germany
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de Souto Barreto P, Sanz C, Vellas B, Lapeyre-Mestre M, Rolland Y. Drug treatment for diabetes in nursing home residents. Diabet Med 2014; 31:570-6. [PMID: 24267150 DOI: 10.1111/dme.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/16/2013] [Accepted: 10/26/2013] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this study was to describe drug treatment for diabetes in a large sample of nursing home residents and to compare subjects' health outcomes according to the anti-diabetic agents used. METHODS The cross-sectional data of 6275 residents [average age 86 years (± 8.2); 73.7% women] from 175 nursing homes in France were analysed. Participants were divided into one of the following four groups: diabetes non-drug treatment, diabetes hypoglycaemic (e.g. insulins, sulphonylurea) treatment, diabetes non-hypoglycaemic (e.g. metformin) treatment and no diabetes. Group comparisons were made on functional ability (activities of daily living score) and on the prevalence of the following variables (yes vs. no): emergency department visits, falls and fractures. RESULTS Of the participants, 1076 (17.1%) had diabetes: 222 participants in the non-drug treatment group, 722 in the hypoglycaemic group and 132 in the non-hypoglycaemic group. The remaining 5199 participants made up the group without diabetes. Insulin and metformin were used by 549 and 185 participants, respectively. Activities of daily living scores differed across the four groups, with those in the non-drug treatment group being the most disabled. Adjusted multivariate analyses showed that, compared with the group without diabetes, those in the hypoglycaemic group had a higher probability of emergency department visits (odds ratio 1.26, 95% CI 1.03-1.54) and increased the incidence rate ratios (1.02, 95% CI 1.00-1.04) of disability (activities of daily living score), whereas the non-hypoglycaemic group was not significantly associated with these outcomes. CONCLUSIONS The use of hypoglycaemic drugs was associated with poor health outcomes in nursing home residents. Therefore, more attention must be paid to adapting anti-diabetic treatment in this complex population.
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Affiliation(s)
- P de Souto Barreto
- Gerontopole of Toulouse, Institut of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UMR7268 Aix-Marseille University Biocultural-Anthropology, Law, Ethics and Health, Marseille, France
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Dietary fiber intake and risk of type 2 diabetes: a dose-response analysis of prospective studies. Eur J Epidemiol 2014; 29:79-88. [PMID: 24389767 DOI: 10.1007/s10654-013-9876-x] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/27/2013] [Indexed: 02/01/2023]
Abstract
Observational studies suggest an association between dietary fiber intake and risk of type 2 diabetes, but the results are inconclusive. We conducted a meta-analysis of prospective studies evaluating the associations of dietary fiber intake and risk of type 2 diabetes. Relevant studies were identified by searching EMBASE (from 1974 to April 2013) and PubMed (from 1966 to April 2013). The fixed or random-effect model was selected based on the homogeneity test among studies. In addition, a 2-stage random-effects dose-response meta-analysis was performed. We identified 17 prospective cohort studies of dietary fiber intake and risk of type 2 diabetes involving 19,033 cases and 488,293 participants. The combined RR (95 % CI) of type 2 diabetes for intake of total dietary fiber, cereal fiber, fruit fiber and insoluble fiber was 0.81 (0.73-0.90), 0.77 (0.69-0.85), 0.94 (0.88-0.99) and 0.75 (0.63-0.89), respectively. A nonlinear relationship was found of total dietary fiber intake with risk of type 2 diabetes (P for nonlinearity < 0.01), and the RRs (95 % CI) of type 2 diabetes were 0.98 (0.90-1.06), 0.97 (0.87-1.07), 0.89 (0.80-0.99), 0.76 (0.65-0.88), and 0.66 (0.53-0.82) for 15, 20, 25, 30, and 35 g/day. The departure from nonlinear relationship was not significant (P for nonlinearity = 0.72), and the risk of type 2 diabetes decreased by 6 % (RR 0.94, 95 % CI 0.93-0.96) for 2 g/day increment in cereal fiber intake. Findings from this meta-analysis indicate that the intakes of dietary fiber may be inversely associated with risk of type 2 diabetes.
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Phan TP, Alkema L, Tai ES, Tan KHX, Yang Q, Lim WY, Teo YY, Cheng CY, Wang X, Wong TY, Chia KS, Cook AR. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Res Care 2014; 2:e000012. [PMID: 25452860 PMCID: PMC4212579 DOI: 10.1136/bmjdrc-2013-000012] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/20/2014] [Accepted: 05/24/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Singapore is a microcosm of Asia as a whole, and its rapidly ageing, increasingly sedentary population heralds the chronic health problems other Asian countries are starting to face and will likely face in the decades ahead. Forecasting the changing burden of chronic diseases such as type 2 diabetes in Singapore is vital to plan the resources needed and motivate preventive efforts. METHODS This paper describes an individual-level simulation model that uses evidence synthesis from multiple data streams-national statistics, national health surveys, and four cohort studies, and known risk factors-aging, obesity, ethnicity, and genetics-to forecast the prevalence of type 2 diabetes in Singapore. This comprises submodels for mortality, fertility, migration, body mass index trajectories, genetics, and workforce participation, parameterized using Markov chain Monte Carlo methods, and permits forecasts by ethnicity and employment status. RESULTS We forecast that the obesity prevalence will quadruple from 4.3% in 1990 to 15.9% in 2050, while the prevalence of type 2 diabetes (diagnosed and undiagnosed) among Singapore adults aged 18-69 will double from 7.3% in 1990 to 15% in 2050, that ethnic Indians and Malays will bear a disproportionate burden compared with the Chinese majority, and that the number of patients with diabetes in the workforce will grow markedly. CONCLUSIONS If the recent rise in obesity prevalence continues, the lifetime risk of type 2 diabetes in Singapore will be one in two by 2050 with concomitant implications for greater healthcare expenditure, productivity losses, and the targeting of health promotion programmes.
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Affiliation(s)
- Thao P Phan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Leontine Alkema
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Division of Endocrinology, National University Hospital and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Kristin H X Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Qian Yang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Ministry of Health, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
- Life Sciences Institute, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Singapore Eye Research Institute, Singapore
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Xu Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tien Yin Wong
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Singapore Eye Research Institute, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
- Yale-NUS College, Singapore
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